The Brookings Institution updated an important study, originally conducted in 2015, showing that, after decades of decline, mortality was rising for white, middle-aged Americans. This original study was startling because mortality rates have generally been declining for many years.

The new report finds this trend continuing for an even broader group of white-adults—those starting at age 25. The study found the mortality rate for whites with no more than a high school degree was approximately 30 percent higher than for blacks in 2015. That's a huge increase from 1999, when the mortality rate for this group of whites was about 30 percent lower than for blacks.

Non-Hispanic whites make up 62 percent of the United States' population, so these trends in the nation's largest population group are an important topic. But the real question this newest Brookings study asked is: Why? The answer to that question is somewhat complicated.

First, education may play a part. The mortality for white Americans with a college degree has continued to decline this century. It isn't just about declining income prospects. The study's authors note that Hispanics and African Americans face many of the same income struggles, but their mortality rates have declined over the same period.

The new paper points to so-called "deaths of despair" for the alarming increase in the mortality rate. The authors, Angus Deaton and Anne Case, stated "We see our story as about the collapse of the white, high-school-educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline." The deterioration in the group's economic and social well-being in turn leads to an increase in these "deaths of despair"—largely caused by suicide, drugs and alcohol.

Importantly for states like Kansas, the new study found that the highest mortality rates from drugs, alcohol and suicide are no longer limited geographically. In 2000, these deaths were centered in the Southwest. By the mid-2000s, they had spread to Appalachia, Florida and the West Coast. Today, they are nationwide.

This Brookings study has important demographic and political ramifications. However, it also is a clear example of the growing realization about how social determinants affect our health. If we are to reverse these and other troubling trends, we must admit that health and healthcare is a much broader and deeper topic than we have thus far been willing to admit.